Produção Nacional
Revisado por pares
A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait
2020; Wiley; Volume: 35; Issue: 9 Linguagem: Inglês
10.1002/mds.28128
ISSN1531-8257
AutoresCarla Silva‐Batista, Andrea Cristina de Lima‐Pardini, Mariana Penteado Nucci, Daniel Boari Coelho, Alana X. Batista, Maria Elisa Pimentel Piemonte, Egberto Reis Barbosa, Luís Augusto Teixeira, Daniel M. Corcos, Edson Amaro, Fay B. Horak, Carlos Ugrinowitsch,
Tópico(s)Balance, Gait, and Falls Prevention
ResumoAbstract Background Exercises with motor complexity induce neuroplasticity in individuals with Parkinson's disease (PD), but its effects on freezing of gait are unknown. The objective of this study was to verify if adapted resistance training with instability — exercises with motor complexity will be more effective than traditional motor rehabilitation — exercises without motor complexity in improving freezing‐of‐gait severity, outcomes linked to freezing of gait, and brain function. Methods Freezers were randomized either to the adapted resistance training with instability group (n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. The primary outcome was the New Freezing of Gait Questionnaire. Secondary outcomes were freezing of gait ratio (turning task), cognitive inhibition (Stroop‐III test), motor signs (Unified Parkinson's Disease Rating Scale part‐III [UPDRS‐III]), quality of life (PD Questionnaire 39), anticipatory postural adjustment (leg‐lifting task) and brain activation during a functional magnetic resonance imaging protocol of simulated anticipatory postural adjustment task. Outcomes were evaluated before and after interventions. Results Only adapted resistance training with instability improved all the outcomes ( P < 0.05). Adapted resistance training with instability was more effective than traditional motor rehabilitation (in improving freezing‐of‐gait ratio, motor signs, quality of life, anticipatory postural adjustment amplitude, and brain activation; P < 0.05). Our results are clinically relevant because improvement in the New Freezing of Gait Questionnaire (−4.4 points) and UPDRS‐III (−7.4 points) scores exceeded the minimally detectable change (traditional motor rehabilitation group data) and the moderate clinically important difference suggested for PD, respectively. The changes in mesencephalic locomotor region activation and in anticipatory postural adjustment amplitude explained the changes in New Freezing of Gait Questionnaire scores and in freezing‐of‐gait ratio following adapted resistance training with instability, respectively. Conclusions Adapted resistance training with instability is able to cause significant clinical improvement and brain plasticity in freezers. © 2020 International Parkinson and Movement Disorder Society
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